Nephrostomy

At UT Southwestern Medical Center, our interventional radiologists provide expert care for people with urinary obstruction. Our team has extensive experience placing and maintaining chronic indwelling nephrostomy tubes to help patients maintain proper kidney function and protect the kidneys from infection.

Nephrostomy Performed by Skilled Specialists

The kidneys are two bean-shaped organs located on each side of the spine in the lower back. They produce urine, which flows to the bladder through narrow tubes called ureters.

When a ureter is blocked and unable to drain urine, doctors may perform a nephrostomy to allow the placement of thin plastic tubes that will divert the urine and prevent kidneys from backing up and malfunctioning. During this procedure, doctors place a hollow, flexible tube into the kidney and connect it to an external drainage bag. This allows urine to easily leave the body. These tubes need to be monitored and changed at regular intervals to work properly.

At UT Southwestern, our interventional radiology (IR) team manages not just the procedure but also provides the complete cycle of care. Our dedicated nephrostomy tube care clinic offers routine nurse visits and serves as the cornerstone to provide much-needed support for patients after the tube is placed. We answer all questions related to tube care, including supplies and follow-up procedures. The IR-driven nephrostomy care model was introduced to fill a gap for these patients and is unique to UT Southwestern.

Nephrostomy: What to Expect

During the procedure, which typically takes less than an hour, the patient lies prone with one side propped up by a pillow. The patient is given pain medication and a sedative to help avoid any pain during the procedure.

Guided by ultrasound and fluoroscopy (live X-ray), our interventional radiologist inserts a needle into the kidney and places a guide wire through the needle. The doctor then positions the nephrostomy tube into the kidney over the wire.

The tube is connected to an external drainage bag, which will need to be emptied periodically. The exit site for the nephrostomy tube will be covered with a dressing. (See care instructions below.)

Nephrostomy Tube Care

Supplies

Weekly needs:

• Shower covers
• Disposable gloves
• 2” x 2” gauze dressing (two pieces)
• Tegaderm or paper tape
• Rubbing alcohol wipes
• Pre-filled 10 ml saline syringe plus

Every 2-3 weeks:

• Nephrostomy replacement bag
• Stopcock
• Microclave connector (blue cap)

Nephrostomy Tube Care and Emptying the Drainage Bag

• The bag needs to stay below the tube exit point on your back at all times. This can be done by using a bag attached to the leg. The bag can be attached with elastic bands. Make sure there is some leeway to lower the risk of it getting pulled out.
  • There is also an option to attach a larger bag at night that can hook on the side of the bed.
• Check often to make sure urine is draining freely and tubing is not kinked.
• Empty bag when it is two-thirds full and before going to sleep for the night.
  • Empty it by turning the knob at the bottom of the bag while over the toilet. If you are measuring your urine for your doctor, you can empty into a container.
  • Once all the urine is drained from the drainage bag, close the drain fully to avoid urine leakage.
  • Flush urine down toilet.

Personal Hygiene and Showering

• Do not get the tube wet. No baths, swimming, or hot tubs. If the tube gets wet, change the dressing immediately to prevent infection.
  • Use a shower cover dressing when showering. This can be one ordered from a medical supply company. Glad Press & Seal plastic wrap also works well.

Dressing Changes

Change every two to three days or when the dressing becomes wet or soiled.

**Because of the location of the dressing, you might need a second person to help with the dressing change.

Dressing change instructions:

1. Wash your hands with soap and water before starting the dressing change. Put on disposable gloves.
2. Remove the dressing, being careful not to pull on the tube. Do not use scissors for the dressing because you could accidentally cut the tube or the stitch.
3. Wash the area with mild soap and water, rinse, and pat dry with a clean cloth. **Never use lotions or ointments unless prescribed by doctor.
4. Look at the site after your dressing is removed. Check for redness around the tube exit site. Check for any discolored or smelly discharge. It is normal to have some brown discharge.
5. If the drain was sutured to the skin, inspect the suture to verify that it is still anchored in the skin.
6. Place gauze around the tube where it exits the body.
   1. You can snip a gauze square about halfway down and then fit it around the tube with half to the left of the tube and half to the right of the tube.
   2. You can also just wrap the gauze around the tube where it exits the body.
7. Cover the gauze around the tube with another full gauze.
8. Put the Tegaderm over the dressing so it completely covers the gauze.
   1. Paper tape can also be used in place of the Tegaderm dressing – just be sure to cover the gauze in full.
9. Secure the nephrostomy tubing. You might want to place one piece of tape across the tube to secure it to your skin. Ensure that the nephrostomy tube does not kink or become pinched.

Flushing the Nephrostomy Tube

The nephrostomy tube needs to be flushed two to three times a week, and more often if urine is draining slowly, to prevent urine from crystallizing and clogging the tube. If the tube becomes clogged, urine will not be able to drain from your kidney into the nephrostomy bag, which could result in an infection. You should flush your nephrostomy tube more often when the urine becomes cloudy or urine draining becomes slow.

Flushing instructions:

1. Gather needed supplies.
2. Wash your hands with soap and water and put on disposable gloves.
3. Your nephrostomy tube may be connected to a stopcock. If so, follow the directions below. Otherwise, if your nephrostomy tube is directly connected to the nephrostomy bag, unscrew the nephrostomy bag from the nephrostomy tube.
4. Clean the white connector on the blue tubing with a rubbing alcohol wipe and then screw the tip of a 10 mL 0.9% saline syringe onto the white connector.
   1. Unscrew the nephrostomy tube bag.
   2. Clean the tube end with an alcohol swab.
   3. Screw the tip of the syringe onto the end of the tube.
5. Slowly push saline in over 5-10 seconds.
6. If it does not push easily, or causes you pain, STOP flushing and call the clinic at 214-645-0983.
7. Watch the tube exit site to see if there is any leakage while flushing.
8. While the syringe is on the tube, clean the nephrostomy bag tube with an alcohol swab.
9. Unscrew the syringe from the tube (there will be saline that drains out), then screw the tubing from the nephrostomy bag back on to the end of the nephrostomy tube.

If your nephrostomy tube is connected to a stopcock, you will connect the 0.9% 10mL saline syringe to the stopcock connector and close the drainage to the nephrostomy bag. This allows the saline to flow into the nephrostomy tube.

Note: Stopcocks on the end of the tubes vary greatly. If you cannot figure out how to close the tube to the bag so you can flush the nephrostomy tube, please call the clinic.

Change the Bag

Change the bag every two to three weeks, depending on if your urine is cloudy or has an odor.

• After flushing, attach the tubing on the new bag instead of the old one. The old bag can be thrown away.
• You might find or hear ways to clean the bag and continue to use them; however, if there is a foul-smelling odor, it is recommended that you change the bag completely.

Support Services for Nephrostomy

The Interventional Radiology Clinic will arrange a virtual nurse visit two weeks after your tube is placed. During your two-week visit the nurse will instruct you about the nephrostomy tube care. The tube will need to be changed every three months.

An appointment will be set up during the virtual visit for your next routine exchange. If you have any tube-related issues such as decreased output/pain, please arrange a virtual visit with the nurse. It is important to identify tube failure early to avoid life-threatening infection.